The APRN Role in Telehealth Nursing Research

Transcription

1 The APRN Role in Telehealth Nursing Research Defining, Integrating and Evaluating Rhonda Cady, MS Cathy Erickson, RN Mary Erickson, DNP Anne Kelly, MD Wendy Looman, PhD Ann Garwick, PhD Stanley Finkelstein, PhD

2 Background Pediatric Primary Care Clinic serving over 600 children with complex health conditions Special Needs Program 30 minute appointments Part time LPN Care Coordinator Licensed as a Health Care (Medical) Home

3 Context of APRN Role TeleFamilies Nursing Study Four year, Three Arm, Randomized Control Trial Determine effectiveness of increasing levels of telehealth care coordination and case management Supported by NIH NINR #R01NR010883, Stanley Finkelstein PhD, P.I. Session 065: Telenursing Triage and Distance Learning, Tuesday, 4:15 PM, Room 19

4 Setting Children s Hospital Primary Care Clinic Population Special Needs Program TeleFamilies Study* Study Group Usual Care: Care Coordination & Triage Telehealth: Care Coordination and Case Management Delivery Mode Role Preparation Telephone LPN / RN Triage Telephone APRN Telephone & Video *NINR R01, PI Finkelstein

5 Critical Issues Defining APRN Role and Scope of Practice in Health Care Home Resources Needed to Implement the Role Clinic Processes that Support Implementation and Evaluation Impact on Usual Care

6 Development of APRN Telehealth Nursing Role ANA Scope and Standards of Practice, Pediatric Nursing

7 Development of APRN Telehealth Nursing Role ANA Scope and Standards, Pediatric Nursing Consensus Model for APRN Regulation

8 Development of the APRN Telehealth Nursing / Care Coordinator Role ANA Scope and Standards, Pediatric Nursing Consensus Model for APRN Regulation Presler s Model of Care Coordination Presler, 1998 Presler, B. (1998). Care coordination for children with special health care needs. Orthopaedic Nursing, March/April (Supplement),

9 Resources Needed to Implement the Role Dedicated Space Electronic Medical Record Integrated Plan of Care Customized Telehealth Documentation Technology HIPAA Compliant Reliable

10 Clinic Processes to Support APRN Providers: Build Relationship / Establish Credibility Nursing Triage Staff: Who Caring for Whom? HIT Staff: Support for non Enterprise Software Role Acceptance by Parent/Guardian Build Relationship / Establish Credibility One Stop Shop Concept

11 Impact on Usual Care Minimize in Research Setting Avoid Contamination of Controls Ł Limiting Best Practice Ideas Maximize in Clinical Setting Facilitate Culture ShiftŁShared Model of Care

12 APRN Care Coordinator for CSHCN Full time role Practice via telephone, videoconference, face to face (no primary or acute care visits) 9 5, Triage system after hours Direct line for families Develop, implement, and manage plan of care

13 APRN Salary Cost Considerations APRN Dedicated Office Space APRN Telehealth Equipment Telephone CC/CM Ł Telephone, Computer Video CC/CMŁWeb Cam, HIPAA compliant Video Conferencing Software, Broadband Internet Connection IT Support Customized EMR Documentation Software Upgrades / Video Troubleshooting Family Telehealth Equipment Telephone CC/CM Ł Telephone Video CC/CMŁWeb Cam, HIPAA compliant Video Conferencing Software, Computer & Broadband Internet Connection 2009 Schmitt Center for Home Telehealth, University of Minnesota 13

14 Issues of Advocacy Reimbursement for telehealth delivered care coordination and case management Product statements of HIPAA compliance Medicaid and annual "yo yo" changes in coverageł family AND provider stress regarding payment and services

15 Future Considerations Rapidly Changing Technology Platforms Real time vs. Store and Forward Care Coordination and Case Management Alignment with Accountable Care Organizations